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The  Recent  Advances  of  Sanitary  Science. 


THE  RELATION  OF  MICRO-ORGANISMS  TO  DISEASE. 


ANNUAL  ADDRESS 


DELIVERED    BEFORE   THE 


among  0||  g$i  mmnt 


AT  NEW  YORK, 


OCTOBER    lOth,    1883, 


HENRY  O.  MARCY,  A.M.,  M.D., 

President  of  the  Academy. 

Member  of  the  British  Medical  Association;  Corresponding  Member  of  the  Medico- 

Chirurgical  Society  of  Bologna,  Italy  ;  Member  of  the  American  Medical 

Association;  Member  of  the  Massachusetts  Medical  Society; 

Fellow  of  the  Boston  Gynaecological  Society,  etc. 


PHILADELPHIA 

1883. 


: 


THE  RECENT  ADVANCES  OF  SANITARY  SCIENCE. 

THE  RELATIONS  OF  MICRO-ORGANISMS  TO  DISEASE. 


The  unexpected  honor  which  one  year  ago  your  kind  suffrages 
conferred  upon  me  in  electing  me  to  preside  over  your  councils,  I 
hold  to  be  equally  shared  by  a  thoughtful  discharge  of  the  duties  of 
the  office.  The  profession  at  large  may  be  congratulated  that  the 
American  Academy  of  Medicine  owes  its  origin  and  existence  to  a 
wide-spread  spontaneity  of  feeling  that  the  times  were  ripe  for  and 
demanded  some  organized  effort  to  aid  as  a  controlling  power  in 
elevating  the  standard  of  medicine  in  our  country.  How  well  thus 
far  we  have  succeeded  must  be  left,  not  to  our  own  prejudiced  views, 
but  rather  to  the  unsparing  criticisms  of  all  interested  in  a  higher 
medical  education.  Since,  by  our  position,  we  have  invited  it,  let 
it  arouse  each  one  of  us  to  yet  better  endeavors  in  the  discharge  of  our 
self-imposed  task.  He  who  studies  the  history  of  medicine  in  a 
broad  philosophic  spirit  will  learn  much  of  both  interest  and  profit. 
Viewed  from  this  standpoint,  its  evolution  in  the  present  generation 
in  common  with  its  sister  sciences,  marks  an  era  in  civilization. 
Differences  of  opinion,  even  on  the  fundamental  factors  of  our 
polity,  have  and  very  likely  will  continue  to  exist.  Other  things 
being  equal,  the  better  trained  and  armed  soldiery  win  and  hold 
the  field.  Whatsoever  the  diversity  of  gifts,  the  profession  should 
be  actuated  by  one  spirit.  Under  its  guidance,  moved  by  a  generous 
rivalry,  the  divine  decree  of  the  golden  rule  should  be  its  only  code. 
In  the  clear  light  of  science  rationalistic  medicine  can  have  no 
rivals,  and  the  isms  and  pathies,  which  smack  of  ignorance  and 
superstition,  will  cease  to  exist.  New  fields  of  investigation,  yet  more 
attractive,  because  nearer  to  the  great  source  of  truth,  will  open, 
and  there  will  arise  a  more  noble  emulation  for  the  still  greater 
advancement  of  a  united  and  harmonious  profession. 

A  few  weeks  since,  as  I  stood  on  the  rock-bound  coast  of  the  Bay 
of  Fundy,  and  beheld  its  insurging  tides,  rising  more  than  half  a 
hundred  feet,  converting  empty  gorges  into  deep  rivers,  and  wide- 
spreading  meadows  into  broad  bays,  I  read  in  this  mighty  unseen 

3 


4 

force  the  symbol  of  the  progress  of  our  age.  The  quiet  waters  of  the 
harbor  of  Louisburg,  whose  blue  expanse  covers  the  w7recks  of  the 
French  and  the  English  armadas  of  a  past  century,  at  whose  stormy 
burial  sank  the  hopes  of  nations  who  would  fain  have  founded  in  a 
new  world  empires  based  upon  the  aggrandizing  ambitions  of  kings 
and  clergy,  gave  no  hint,  save  in  the  mournful  desolation  of  its 
shores,  of  a  fatal  policy  which  so  long  dominated  the  ages  of  the 
past.  In  the  busy  subdivided  occupation  of  happy  peoples,  each 
individual  addingtothe  common  store  of  good,  national  interests  inter- 
woven in  one  grand  commonalty  by  the  iron  bands  of  commerce,  we 
mark  the  monuments  of  our  age,  in  the  elevating  of  the  masses  to  a 
higher  plane  of  intellectual  and  moral  development  than  the  world 
has  ever  seen. 

In  the  proud  contemplation  of  such  progress,  the  thought  arises, 
have  the  science  and  art  of  medicine  grown  in  ratio  with  the  general 
development  of  the  age  ?  To  discuss  a  question  of  such  magnitude 
in  the  short  hour  at  my  disposal  would  provoke  a  smile.  And  yet, 
stimulated  by  the  belief  that,  although  proud  of  present  progress,  wTe 
are  on  the  eve  of  far  greater  discoveries  and  clearer  knowledge,  we 
would  counsel  and  urge  upon  the  Academy  the  greatest  devotion  and 
most  enthusiastic  zeal  in  elevating  the  standard  of  medical  education. 

The  late  lamented  Dr.  Edward  H.  Clarke,  of  Boston,  whose 
memory  is  enshrined  in  the  loving  remembrance  of  many  classes  of 
pupils,  divided  the  teachings  upon  materia  medica  into  a  course 
for  two  years,  one  devoted  entirely  to  the  circumfusa  of  the  patient, 
and  one  to  the  medicines  which  might  be  administered.  In  a  some- 
what similar  spirit  I  would  divide  the  duties  of  our  profession,  and 
would  place  first  the  prevention  rather  than  the  cure  of  disease. 

Sanitation  can  hardly  be  called  a  science.  Many  of  its  most 
important  factors  are,  at  the  best,  but  imperfectly  understood.  The 
sanitary  laws  instituted  by  Moses  are  based  upon  principles  which 
cannot  be  under-estimated  or  ignored,  and  the  Egyptians  for  centu- 
ries previous  had  understood  some  sanitary  questions  and  their 
solution  better  than  ourselves.  The  traveler  to-day  may  see  in  the 
elegant  courts  of  the  old  Pompeian  houses  the  marble  basins,  with 
their  leaden  pipes  and  stop-cocks  still  seemingly  ready  to  turn  the 
treasured  waters  of  the  distant  mountain  into  their  old,  time- 
accustomed  channels,  alike  to  bath  and  fountain,  and  go  again  sing- 
ing in  joyous  cadence,  ministering  to  need  and  pleasure  as  they 
found  their  way  through  the  once  busy  city  to  the  bay  below.     Our 


modern  system  of  water  carriage  to  remove  sewage  is  but  the 
adaptation  of  means  to  ends  well  recognized  by  the  ancients,  and 
it  would  to-day  be  difficult  to  find  a  better  specimen  of  sewer  or 
masonry  than  the  Cloaca  Maxima  of  old  Rome. 

That  age  of  Grecian  prosperity  and  extraordinary  intellectual 
activity,  which  gave  to  the  world  Pericles,  Sophocles,  Aristophanes, 
Pindar,  Plato,  Xenophon  and  Socrates,  also  furnished  Hippocrates, 
the  father  of  medicine.  He  it  was  who  formulated  the  fundamental 
principles  of  sanitary  science,  "  Pure  air,  pure  water,  and  a  pure  soil." 
The  little  island  of  Cos  was  his  home,  and  here  was  located  one  of  the 
most  celebrated  temples  of  the  Asclepiadse,  or  priest  physicians  of 
the  Greeks.  If  Hippocrates,  living  upon  this  pearl  of  the  JEgean 
archipelago,  whose  leafy  groves  were  musical  in  the  evenly- 
tempered,  balmy  breezes  which  ever  played  in  health-giving  zephyrs, 
whose  gentle  rills  were  fed  from  springs  gushing  forth  the  distilled 
dews  of  heaven,  whose  verdant  slopes,  basking  in  the  clear,  warm 
suulight,  were  kissed  by  the  deep  blue  waves  of  the  Mediterranean, 
the  very  place  of  ideal  purity  and  loveliness,  recognized  the 
importance  of  such  maxims,  what  should  be  their  value  to  the 
multitudes  crowded,  at  the  behest  of  commerce,  in  localities  selected 
without  thought  of  sanitary  surroundings  ? 

The  discussion  of  the  problems  of  life,  and  the  important  factorage 
of  ills  thereto  belonging,  by  the  wise  and  thoughtful  of  the  ages  long 
ago,  is  not  alone  instructive,  but  has  a  fascination  of  its  own. 
Whatever  else  may  be  said  of  Mohammedism  as  a  code  of  morals 
and  virtue,  its  cardinal  principles  of  cleanliness  and  careful  living 
deserve  special  recognition  at  the  hands  of  science.  The  great 
plagues  of  the  Middle  Ages  and  the  desolations  following  the  Crusades 
which  swept  over  Europe,  were  filth  diseases  of  a  preventable  char- 
acter. Although  spurred  into  recognition  by  the  bitter  experiences 
of  the  passing  generations,  sanitary  science  is  yet  under  only  partial 
recognition  of  the  laws,  and  a  popular  interest  is  scarcely  aroused, 
even  among  our  more  intelligent  classes  of  citizens. 

The  vital  processes,  in  their  sway  over  matter,  hold  the  balancing 
between  waste  and  repair.  This  hypothetical  equilibrium  is  perhaps 
the  best  definition  of  health,  and  the  safe  removal  of  the  waste,  worn-out 
material,  is  one  of  the  chief  factors  of  sanitary  science.  This,  to  the 
individual  as  ordinarily  situated,  might  seem  a  question  for  easy 
solution.  In  the  wide  stretches  of  country  surroundings,  although 
there  are  many  exceptions,  this  is  generally  true,  but  in  the  crowded 


6 

conditions  of  city  life  there  is  no  problem  more  pressing  or  complex. 
The  law  of  decomposition  is  vital  rather  than  chemical,  and  in  the 
changes  which  ensue  there  are  reproduced,  in  the  most  marvelous 
abundance,  lower  forms  of  microscopic  vegetable  life,  which  in  their 
death-dealing  danger  are  far  more  potent  than  the  evolution  of 
noxious  gases.  The  relation  between  the  house  we  occupy,  its  loca- 
tion and  surroundings,  its  water  supply  and  the  best  means  of 
removal  of  waste,  are  as  yet  but  imperfectly  understood.  The  local 
causes  in  the  production  of  disease  are  occupying  in  a  greater  degree 
at  present  than  ever  before  the  best  scientists  of  the  medical  profession. 
Although  many  vital  points  are  yet  undetermined,  great  progress 
has  been  and  .is  being  made.  It  is  sufficiently  established  that  the 
water  drank  which  is  contaminated  with  the  specific  infection  of 
cholera,  typhoid  fever,  and  other  diarrhceal  diseases,  will,  at  least  in 
certain  conditions  of  the  system,  reproduce  these  diseases,  and  if  these 
conditions  are  wide-spread  an  epidemic  will  ensue.  A  similar  law 
holds  good  in  reference  to  malarial  or  intermittent  fever,  although 
it  is  very  probable  the  sources  of  contamination  are  not  confined  to 
the  water  supply  alone.  Heat,  moisture,  and  the  resulting  decom- 
position are  the  seeming  gross  factors,  but  it  is  quite  certain  that 
minute  living  organisms  introduced  into  the  system  are  the  potent 
factors  in  the  production  of  these  diseases. 

The  condition  which  this  age  of  steam  brings,  with  its  modern 
miracle  of  civilization,  massing  the  population  in  great  centres, 
gives  new  sanitary  problems  of  a  very  difficult  and  complex  char- 
acter. 

Surrounded  by  a  media  from  which  there  is  even  momentarily  no 
escape,  and  which  we  must  ever  breathe,  atmospheric  impurities 
must  be  considered  as  of  the  highest  importance.  The  air  has  no 
absolutely  fixed  normal  composition ;  however,  its  two  essential 
elements,  oxygen  and  nitrogen,  under  ordinary  circumstances,  are  so 
nearly  invariable  they  may  be  regarded  as  stable  factors.  Although, 
in  a  simple  mechanical  mixture,  the  air  is  very  rarely  free  from 
carbonic  acid  and  water,  yet  carbonic  acid,  so  far  as  known,  is  a 
harmless,  but  superfluous  agent  to  the  animal  economy,  while,  on  the 
contrary,  to  the  vegetable  world  it  is  food  of  the  most  important 
character.  Some  plants  go  through  their  entire  period  of  evolution 
dependent  only  upon  this  element  and  water. 

The  mechanical  admixture  of  water  in  the  form  of  vapor  is  a 
constantly  varying  factor,  dependent  upon  location,  climate,  temper- 


ature,  etc.,  and,  although  rarely  entirely  absent,  is  of  itself  an 
element  comparatively  unimportant,  but,  combined  with  other 
factors,  it  makes  possible  the  development  of  lower  forms  of  the 
vegetable  organisms,  to  which  we  are  now  warranted  in  ascribing 
some  of  the  most  dangerous  and  wide-spread  diseases  of  the  entire 
animal  kingdom.  In  its  indirect  bearings  upon  climatology, 
influence  upon  heat,  etc.,  atmospheric  moisture  is  of  the  first 
importance. 

In  the  analysis  of  air,  ozone,  from  its  admitted  powers,  especially 
in  its  bearing  upon  climate  and  health,  should  be  carefully  consid- 
ered. It  is  an  allotropic  form  of  oxygen  which  has  attained  new 
properties,  of  an  intensely  active  character,  supposed  to  have  been 
chiefly  produced  by  the  action  of  electricity.  Its  molecular  weight 
is  48,  oxygen  32,  and  its  density  is  about  one  and  one-half  times 
greater  than  oxygen.  According  to  Houzeau,  the  maximum 
quantity  of  ozone  in  the  air  never  exceeds  yooWo  Par^  °f  ^s  bulk, 
and  it  is  often  entirely  wanting.  More  ozone  is  found  during  the 
night  than  the  day  ;  in  winter  than  in  summer  ;  upon  high  rather 
than  low  lands ;  in  country  than  in  town  ;  and  most  of  all,  after  a 
severe  thunderstorm. 

Ozone  owes  its  great  value  as  a  disinfecting  agent  to  its  exceed- 
ingly powerful  oxidizing  qualities.  The  compounds  of  ammonia, 
phosphorus  and  sulphur  are  acted  upon  with  great  rapidity,  and 
the  odors  resulting  from  animal  decomposition  are  removed  instantly. 
It  is  probably  destructive  to  all  the  minute  vegetable  organisms 
when  in  active  development,  but  its  effect  in  destroying  the  vitality 
of  the  spores  of  plants  has  not  yet  been  determined. 

From  the  exceedingly  active  properties  of  ozone  in  destroying  the 
low  forms  of  vegetable  organisms,  and  consequent  prevention  of 
putrefaction,  as  well  as  the  induction  of  catarrhal  affections,  when 
experimented  with  artificially,  the  important  query  of  its  value  as 
a  factor  of  atmospheric  composition,  and  its  relationship,  if  any,  to 
epidemic  diseases,  has  arisen.  A  committee  of  the  American 
Medical  Association,  under  the  efficient  leadership  of  Dr.  N.  S. 
Davis,  of  Chicago,  during  the  last  three  years  has  been  doing  a 
considerable  amount  of  work  in  the  solution  of  this  important,  but 
complex  problem.  Under  their  direction,  careful  tests  to  determine 
the  amount  of  ozone  in  the  atmosphere  are  daily  made  in  a  number 
of  our  large  cities,  in  which  localities,  clinical  records  are  taken  by 
a  number  of  independent  observers,  to  ascertain  the  initial  date  of 


8 

acute  diseases.  Reports  of  progress  have  been  made,  but  sufficient 
data  have  not  been  secured  to  warrant  any  general  conclusions. 
The  committee  desire  a  wider  interest  and  assistance  in  the  further 
accomplishment  of  a  work  which  promises  to  be  of  great  value. 

1 "  There  is  much  evidence  in  favor  of  adopting  the  analysis  for 
oxygen,  instead  of  that  of  carbonic  acid,  as  a  test  of  atmospheric 
purity  ;  the  test  would  be  an  absolute  one,  if  we  could  be  sure  of 
the  uniformity  of  the  proportion  of  oxygen  in  pure  air.  Taking 
this,  as  we  probably  may,  for  granted,  we  can  say  that  the  carbonic 
acid,  in  most  cases,  increases  directly  at  the  expense  of  the  oxygen 
of  the  air,  and  therefore  a  diminution  of  oxygen  points  logically  to 
an  increase  of  carbonic  acid.  There  is  this  disadvantage  in  taking 
the  oxygen  test,  it  removes  from  view  the  accidental  impurities,  such 
as  the  discharges  from  chimneys,  wThich  are  certainly  important." 

Carbonic  acid  is  a  product  of  combustion,  and  in  its  formation 
represents  in  nearly  fixed  ratio  the  destruction  of  oxygen.  The 
entire  animal  kingdom  is  constantly  consuming  oxygen  and  emitting 
carbonic  acid,  and  atmospheric  conditions  dangerous  to  life  would 
ensue,  were  it  not  for  the  equilibrium  maintained  by  the  consump- 
tion of  carbonic  acid  and  generation  of  oxygen  by  vegetable  growth. 
Owing  to  the  remarkable  diffusion  of  gases,  the  wind  currents,  etc., 
the  immense  amount  of  carbonic  acid  poured  out  into  the  air  as  the 
product  of  combustion  never  produces  atmospheric  changes  in  any 
marked  degree.  It  is  estimated  by  Smith  that  in  Manchester,  from 
this  source  alone,  over  fifteen  tons  of  carbonic  acid  are  produced 
daily,  and  yet,  when  this  is  added  to  the  product  of  respiration  and 
animal  waste,  he  found  the  entire  quantity  was  not  sufficient  to 
raise  the  average  percentage  above  four  parts  in  ten  thousand, 
which  is  within  the  so-called  normal  limits  of  a  number  of  investi- 
gators. The  decided  increase  of  carbonic  acid  in  cities  is  due 
mainly  to  the  confinement  of  air  in  courts  and  alleys,  and  the 
sanitary  lesson  should  be,  the  construction  of  wide  streets,  with  open 
courts  or  squares. 

Too  much  importance  has  been  placed  upon  carbonic  acid  as  a 
deleterious  constituent  of  the  atmosphere.  Very  little,  if  any, 
annoyance  is  felt  from  the  accidental  escape  of  pure  carbonic  acid 
in  the  charging  of  soda  fountains,  although  the  air  may  contain  two 
per  cent,  of  the  gas.     Forster  states  that  he  had  no  difficulty  in 

1  "The  Atmosphere.''  By  D.  F.  Lincoln,  m.  d.,  Ziemssen*s  Cyclopaedia, 
Vol.  xviii,  page  6Uo. 


9 

remaining  ten  minutes  in  a  cellar  containing  fermenting  wine, 
although  the  carbonic  acid  gas  amounted  to  forty  parts  per  thousand. 

There  is  a  vast  difference  when  the  oxygen  is  lessened  in  propor- 
tion as  the  carbonic  acid  is  increased,  as,  for  example,  the  entering 
of  a  chamber  where  candles  are  burnt  until  extinguished  for  want 
of  oxygen  ;  or  again,  where  the  carbonic  acid  is  produced  by  respi- 
ration. The  presence  of  this  gas  in  living-rooms  in  any  appreciable 
quantity  is  of  first  importance,  not  so  much  as  a  deleterious  chemical 
agent,  as  because  of  the  bad  company  in  which  it  is  found,  and  the 
presence  of  which  it  indicates.  One  serious  objection  to  the 
numerous  gas-jets  of  the  brilliantly  lighted  salon  and  audience 
room  is  found  in  the  fact  that  the  ordinary  burner  consumes  as 
much  oxygen  as  four  persons.  From  a  sanitary  standpoint,  lighting 
our  homes  by  electricity  will  be  a  great  gain,  and  this  evil  obviated. 
One  large  room  in  a  Lowell  mill,  lighted  by  four  hundred  gas 
burners,  had  been  ever  a  source  of  complaint  in  its  defective  venti- 
lation and  great  heat.  Lighted  by  electricity,  the  change  was 
surprising,  while  the  difference  in  temperature  was  over  twenty 
degrees. 

Products  of  decomposition  from  cess-pools,  the  organic  exhala- 
tions from  respiration,  the  lessening  of  oxygen  from  the  combustion 
which  is  going  on  in  the  brilliantly  lighted  rooms,  all  these  are 
dangerously  infective  and  devitalizing  elements  which  demand  a 
system  of  ventilation  usually  ignored  in  modern  house-construction. 

From  the  address  upon  State  Medicine  before  the  American 
Medical  Association  at  St.  Paul,  1882,  by  Dr.  Gihon,  Medical 
Director,  U.  S.  K".,  I  quote,  all  too  briefly,  "  So  long,  however,  as 
society,  in  its  highest  development  of  rank  and  culture,  ignorantly 
jostles  and  wedges  itself  in  contracted  parlors  and  drawing-rooms, 
already  defiled  by  blazing  gas-jets  and  defective  furnaces,  where 
hundreds  of  lavishly  dressed  human  machines  befoul  the  air  and 
poison  one  another  with  the  noxious  gases  and  their  own  effete 
animal  products  in  deadlier  quantity  than  the  ragged  rabble  which 
herd  in  the  open  street,  and  call  this  pleasure ;  so  long  as  godly 
people  drowse  and  yawn  in  badly  ventilated  churches,  surcharging 
their  brains  and  impairing  their  minds  with  blood  not  half  aerated, 
and  ungodly  ones  exhaust  their  whole  reserve  force  to  resist  the 
insanitary  influence  of  the  no  less  badly  ventilated  theatre  and 
exhibition  hall,  and  call  the  one  pious  worship  and  the  other 
rational  amusement:  so  lona:  as  men  toil  to  amass  riches  and  then 


10 

build  residences  palatial,  or  sham  palatial,  and  in  the  name  of 
luxury  and  sestheticism  flood  them  with  artificial  light  and  heat  to 
consume  the  oxygen  which  prince  and  beggar  must  breathe,  and 
admit  the  invisible  filth  by  the  sumptuously  decorated  closet  and 
bathroom  by  which  they  think  to  exclude  the  vile  necessities  of 
humanity  which  prince  and  beggar  alike  cannot  escape,  and  call 
this  comfort  and  refinement ;  so  long  as  our  children  are  sent  to 
overcrowded  and  unwholesome  schools,  where  their  eyes  are  bleared, 
their  hearing  dulled,  their  plastic  bodies  distorted  and  their  brains 
fuddled,  and  call  this  education  ;  so  long  as  men  and  women  violate 
daily  in  themselves  and  in  their  children  the  simplest  precepts  of 
hygiene,  parents  countenancing  half-dressed  daughters  wearing  out 
their  strength  in  unwholesome  ball-rooms,  seeking  their  slumber  that 
cannot  refresh  only  when  dawn  appears ;  sons  launched  upon  the 
world  to  encounter  physical  wreck  in  a  thousand  channels  where  no 
beacon  warns  of  danger;  old  men,  senators,  judges,  divines,  per- 
chance learned  doctors,  uncomplainingly  breathing  the  foul  air  of 
public  conveyances  and  apartments  in  which  every  door  and  window 
have  been  carefully  closed  and  ventilator  carelessly  ignored ;  streets 
reeking  with  filth  which  decrepid  laborers  play  the  farce  of  sweeping 
in  broad  daylight ;  what  can  State  Medicine  hope  to  accomplish  in 
legislative  chambers  and  halls  of  Congress  which  are  themselves 
even  evidences  of  sanitary  ignorance,  sanitary  neglect  and  sanitary 
indifference  ?  " 

The  foreign  ingredients  of  the  atmosphere  are  very  various ;  as 
dust  they  are  carried  great  distances  by  the  wind  and  deposited 
often  hundreds  of  miles  from  their  source.  African  organisms  have 
been  found  in  the  air  of  Berlin.  It  is  often  difficult  to  obtain  air 
free  from  the  pulverulent  debris  of  vegetation,  and  both  vegetable 
and  animal  organisms  abound.  From  the  vegetable  kingdom  come 
pollen,  vegetable  hairs,  fibres,  scales,  cells,  seed  capsules,  etc.,  also 
spores  of  fungi  and  various  forms  of  bacterial  growths  in  marvelous 
abundance.  In  the  air  of  living-rooms  we  may  find  portions  of 
food,  animal  and  vegetable  fibres,  pus  globules,  fatty  crystals,  scaly 
epithelium,  and  a  number  of  the  micro-organisms. 

1  Dr.  Sternberg,  in  his  Report  to  the  Xational  Board  of  Health, 
says:  "The  fact,  observed  by  myself,  that  during  the  summer 
months  the  mud  in  the  gutters  of  New  Orleans  possesses  an  extra- 
ordinary degree  of  virulence,  shows  that  pathogenic  varieties  of 

1  Special  Report  to  Xational  Board  of  Health.  April  30,  1881. 


11 

bacteria  are  not  alone  bred  in  the  bodies  of  living  animals.  The 
more  I  study  this  subject  the  more  probable  it  seems  to  me  that  in 
this  direction  lies  the  explanation  of  many  problems  which  have 
puzzled  epidemiologists,  and  that  the  sanitarians  are  right  in  fighting 
against  filth  as  a  prime  factor  in  the  production  of  epidemics ;  a 
factor  of  which  the  role  is  easily  understood,  if  this  view  is  correct. 
The  presence  of  septic  organisms,  possessing  different  degrees  of 
virulence,  depending  upon  the  abundance  and  kind  of  pabulum 
furnished  them,  and  upon  meteorological  conditions  more  or  less 
favorable,  produces,  in  my  opinion,  the  epidemic  constitution  of  the 
atmosphere,  which  wise  men  were  wont  to  speak  of  a  few  years  ago 
as  a  cloak  for  ignorance.  It  must  be  remembered  that  the  gutter 
mud  of  to-day,  with  its  deadly  septic  organisms,  is  the  dust  of 
to-morrow,  which,  in  respiration,  is  deposited  upon  the  mucous 
membrane  of  the  respiratory  passages  of  those  who  breathe  the  air 
loaded  with  it." 

The  spores  of  certain  forms  of  these  lower  orders  of  vegetation 
have  a  remarkable  vitality.  They  are  of  extreme  minuteness,  often 
less  than  a  two  hundred  thousandth  of  an  inch  in  diameter  and 
have  resisted  a  dry  heat  quite  above  boiling  water.  Tyndall  was 
the  first  to  make  popular  the  test  of  a  beam  of  light  through  the 
air  as  one  of  the  best  to  show  the  presence  of  minute  particles. 
Indeed,  it  is  only  owing  to  these  particles  that  the  beam  of  light  is 
revealed,  for  in  purified  air  it  ceases  to  be  visible,  and  air  thus 
purified  no  longer  possesses  the  power  of  exciting  putrefaction  in 
albuminous  fluids  previously  sterilized.  From  the  almost  universal 
pi'esence  of  these  minute  forms  of  micro-organisms  and  their  diffi- 
culty of  exclusion  arose  the  belief  in  spontaneous  generation.  Owing 
to  a  better  knowledge  of  these  organic  constituents  ever  present  in 
confined  spaces  and  the  dangers  therefrom  to  wounds,  has  arisen 
the  revolution  in  surgery  during  the  last  decade. 

By  a  slower  process,  because  beset  with  far  greater  complications 
and  difficulties,  there  is  being  surely  evolved  the  so-called  germ 
theory  of  disease  which,  although  not  dependent  upon  the  atmos- 
phere alone  for  the  spread  of  contagion,  is  the  more  usual  medium 
for  the  dissemination  of  infection.  The  organic  matter  exhaled 
from  the  lungs  is  molecular  and  is  disseminated  by  atmospheric 
currents.  The  odor  from  the  decomposition  of  these  organic 
elements  is  generally  perceptible  when  the  carbonic  acid  reaches 
seven  parts  in  ten  thousand,  and  is  strong  when  it  amounts  to  ten 


12 

parts.  The  microscopic  examination  of  these  exhalations  into  the 
air  of  crowded  rooms,  when  condensed  with  the  vapors  upon  the 
cold  glass  of  the  window,  often  shows  them  to  be  undergoing  decom- 
position, in  the  process  of  which  are  developed  confervoid  growths 
intermingled  with  myriads  of  bacteria  and  micrococci.  One  danger 
from  tuberculous  patients  may  be  found  in  the  careless  disposition 
of  the  sputum.  This  not  seldom  falls  to  the  ground,  is  pulverized 
and  distributed  as  dust.  In  respiration  of  the  atmosphere  thus 
infected,  the  bacilli  are  lodged  upon  the  mucous  membrane  of  the 
lungs.  In  the  laborious  researches  recently  published  of  M.  Vignal, 
of  Paris,  upon  the  bacillus  of  tubercle,  he  dried  in  a  flat  receptacle 
some  sputum  containing  bacilli ;  this  he  afterwards  pulverized,  then 
moistened  and  subsequently  dried.  The  specimen  was  in  this  way 
moistened  and  dried  eight  times,  and  the  bacilli  were  as  abundant 
as  in  the  fresh  sputum. 

Owing  to  the  multiplicity  of  agents  and  causes  rendering  air 
impure,  its  analysis  has,  as  a  rule,  been  very  uncertain  and  unsatis- 
factory. The  term  albuminoid  ammonia,  much  used  in  the  analysis 
of  air  as  well  as  of  water,  has  usuallv  represented  a  whole  series  of 
unknown  factors.  Like  amaurosis  of  the  eye  by  the  older  writers, 
it  gave  a  learned  phraseology  to  ignorance  and  disfigured  science, 
much  in  keeping  with  the  making  of  the  geographical  map  of  our 
boyhood,  where  the  vast  unexplored  region  of  the  territories  this 
side  of  the  Rocky  Mountains  was  called  the  Great  American  Desert. 

It  was  first  noticed  by  Gay  Lussac  that  all  the  nitrogen  of 
organic  matter,  when  heated  with  caustic  hydrates,  appeared  as 
ammonia.  Albuminoid  compounds,  when  disorganized  by  the 
growth  of  the  lower  forms  of  organisms,  set  free  ammonia,  and  the 
quantity  of  the  free  ammonia  may,  in  a  general  way,  serve  as  a 
standard  to  indicate  the  amount  of  decomposition  which  has  taken 
place. 

The  term  albuminoid  ammonia,  on  the  contrary,  stands  for  the 
quantity  of  nitrogenous  material  in  air  or  water  which  may 
serve  as  food  for  the  growth  of  these  infinitesimal  organisms.  This 
as  yet  undecomposed  oi'ganic  matter  is  not  by  any  means  in  itself 
necessarily  hurtful,  although  always  objectionable.  Combined  with 
moisture  at  ordinary  temperatures,  it  furnishes  the  condition  for 
bacterial  growth  and  may  prove  sufficient  for  the  development  and 
spread  of  an  epidemic  of  some  one  of  the  class  of  contagious  diseases. 
AVe  can  have  no  chemical  test  for  discriminating-  between  hurtful 


13 

and  harmless  organic  matter,  since  the  poisonous  infection  is  vital, 
and  where  found  must  ever  be  looked  upon  with  suspicion. 

I  take  great  pleasure  in  referring  to  the  microscopic  investigations 
of  atmospheric  impurities  by  Surgeon  J.  H.  Kidder,  U.  S.  N.,  Wash- 
ington, published  in  the  Report  of  the  Surgeon  General,  U.  S.  N., 
1880,  and  continued  in  report  for  1881,  by  Passed  Assistant  Surgeon 
T.  H.  Streets. 

The  material  for  examination  was  collected  by  the  use  of  a  funnel- 
shaped  instrument  connected  to  a  winged  vane,  causing  the  opening 
to  face  the  air  current,  which  is  made  to  impinge  upon  a  slide  placed 
horizontally,  a  portion  of  which  has  been  moistened  in  glycerine. 
In  out-of-doors  air  thus  collected  and  examined,  he  enumerates  the 
following  substances  as  the  most  important : — 
"1.  Epithelium  from  the  skin  and  mucous  membranes. 

2.  Vegetable  epithelium  and  unrecognized  debris. 

3.  Hairs  and  threads  of  various  fabrics. 

4.  Particles  of  sand,  glass,  metals,  soot  and  starch. 

5.  Parts  of  the  chitinous  shells  of  small  insects. 

6.  Bits  of  feathers  and  the  pappous  bristles  of  composite  plants. 

7.  Minute,  highly  refracting  dots,  simulating  micrococcus. 

8.  Crystals  of  various  forms  and  sizes. 

9.  Pollen  spores  of  many  different  kinds. 

10.  Leaf  hairs. 

11.  Mycelium  and  spores  of  fungi. 

12.  Nucleated  cells  resembling  leucocytes. 

13.  Bacteria,  as  bacterium,  vibrio,  bacillus  and  micrococcus,  and 
under  the  forms  of  aggregation  known  as  zooglcea,  "swarms,"  lepto- 
ihrix  and  torulaP 

Dust  collected  dry,  by  simple  exposure  of  slips  and  disks  to  the 
air,  contained  sand,  soot,  etc.,  and  numerous  crystals,  mostly  rods 
and  radiating  needles.  And,  finally,  the  disks  and  tubes  containing 
collections  made  in  hospital  wards  abounded  in  epithelium,  starch, 
cells  resembling  leucocytes,  and  threads  and  hairs.  Epithelium, 
as  appears  from  the  foregoing  summary,  is  always  and  everywhere 
present  in  the  air.  Considering  the  probability  of  the  communica- 
tion of  contagious  exanthemata  by  this  mode,  the  constant  presence 
of  epithelium  in  the  air  becomes  a  fact  of  considerable  hygienic 
importance.  Minute,  highly-refracting  dots,  very  numerous  in 
winter  dust,  are  likely  to  be  mistaken  for  micrococcus,  especially 
when  mounted  in  fluid  and  agitated  by  the  Brownian  movement. 


14 

"  They  are  usually  the  most  minute  parts  of  coal  ashes,  and  may 
be  distinguished  from  organic  forms  by  the  fact  that  they  are  not 
affected  by  strong  sulphuric  acid.  *  *  *      After  a  long 

series  of  observations  I  am,  however,  constrained  to  believe  that 
there  is  no  absolute  reliance  to  be  placed  upon  identity  or  similarity 
of  form  in  the  recognition  of  crystals  occurring  in  dilute  solutions." 
•Jn  the  sanitary  investigations  of  Dr.  Streets,  the  cultivation  of 
the  organisms  of  atmospheric  dust  gave  most  interesting  results. 
The  rare  form  of  bacillus  ruber  accidentally  appeared  in  some  of  the 
culture  tests  and  was  made  the  subject  of  a  number  of  laboratory 
studies,  and  from  their  cultivation  the  air  of  the  laboratory  became 
so  completely  infected  with  them  that  unless  extraordinary  care 
was  exercised  they  appeared  as  a  pervading  element  in  all  cultures. 
From  my  own  laboratory  studies  I  have  been  made  aware  of  the 
great  difficulty  in  excluding  germs  during  the  manipulation  of 
sterilized  nutrient  fluids.  To  the  special  student,  Dr.  Street's 
observations  are  of  great  interest.  I  cannot  forbear  quoting  con- 
cerning his  growing  the  bacillus  ruber  upon  rice  under  a  bell  jar  in  a 
darkened  room.  "  Whenever  the  bell  glass  was  removed  the  nostrils 
were  greeted  by  an  agreeable  odor  of  apples ;  several  persons 
noticed  it.  *     The  bacillus  (Beck's  Ko.  10  immer- 

sion) was  shown  to  be  in  single  rods  or  two  joined  together,  rarely 
four  or  more  united.  Each  rod  enclosed  two  brightly  refracting 
granules  usually  one  at  either  end.  The  movement  of  the  rods  was 
active  and  perpendicular  to  the  stratum  of  liquid  in  which  they 
swam  ;  moving  points  only  were  seen  coming  apparently  in  contact 
with  the  thin  glass  cover;  as  their  motion  became  less  active  the 
rods  floated  horizontally  in  the  liquid." 

A  proper  discussion  of  the  impurities  in  water  would  far  exceed 
the  limits  of  this  entire  paper.  Chemically  pure  drinking  water  is 
neither  necessary  nor  wholesome.  Soaking  into  the  earth,  certain 
mineral  constituents  must  be  present  in  varying  quantity.  These 
have  long  been  recognized  and  may  be  easily  determined.  In  all 
natural  waters  there  is  more  or  less  organic  matter  in  solution. 
This  is  reduced  to  the  minimum  in  the  supply  from  springs  and 
deep  wells  properly  protected.  Organic  material  may  not  be 
injurious,  dependent  upon  its  character;  dissolved  vegetable  material 
may  deeply  color  the  water,  or  the  low  form  of  algse  give  it  a  very 
disagreeable  taste  without  being  especially  harmful ;  on  the  con- 
trary clear,  sparkling,  tasteless  water  may  contain  impurities  in  the 


15 

highest  degree  dangerous.  Water  containing  albuminoids  in  solu- 
tion, if  allowed  to  become  standing,  is  sure  to  undergo  deleterious 
changes,  from  its  infection  by  the  ever  present  atmospheric  germs 
which  utilize  these  products  as  food  and  reproduce  in  numbers 
utterly  beyond  conception.  It  is  owing  to  such  infection  that  the 
water  drainage  from  swamps  and  marshes,  especially  in  hot  climates, 
has  ever  been  a  prolific  source  of  intestinal  disease. 

As  in  the  discussion  of  atmospheric  impurities,  we  found  the 
ever-present  moisture  an  important  factor,  so  in  the  treating  of  the 
water  supply,  soil  pollution  must  be  necessarily  therewith  taken 
into  consideration.  In  this  relation  no  question  is  more  important 
than  the  power  of  the  soil  to  purify  water  by  filtration  and  the 
retention  therein  of  injurious  products.  The  albuminoid  compounds 
may  here  be  utilized  as  food  for  the  higher  order  of  plants,  and 
thus  be  extracted  from  the  aqueous  solution.  Under  the  influence 
of  sunlight  oxidation  destroys  many  of  the  lower  growths,  and  air 
and  water  both  thus  become  purified.  It  has  long  been  recognized 
that  certain  soils  in  time  lose  their  ability  to  filter  out  the  impuri- 
ties from  polluted  waters.  Many  cases  of  disease  and  even  epi- 
demics have  been  traced  directly  to  the  use  of  water  containing 
sewage  that  had  passed  a  greater  or  less  distance  through  the  soil. 
It  is  apparent  that  this  danger  has  been  greatly  underestimated  by 
all  classes.  The  specific  contamination  of  the  ground  water  and 
thereby  of  the  supply  for  household  use,  is  the  more  common  and 
wide-spread  source  of  certain  of  our  most  dangerous  diseases,  the 
example  of  which  best  known  is  typhoid  fever.  It  is  also  an  estab- 
lished fact  that  the  air  which  everywhere  permeates  all  soils  to  the 
ground  water,  moves  in  consonance  with  every  barometric  change  of 
the  outer  atmosphere ;  these  air  currents,  also  modified  by  heat,  are  of 
importance  from  a  sanitary  standpoint.  Every  vault,  every  cess- 
pool, is  a  source  of  pollution,  and  these  subsoil  air  currents  are 
drawn  into  our  cellars  from  all  directions  when  they  are  used  as  is 
the  custom  of  most  of  our  northern  cities,  as  the  source  from  which 
the  heat  in  winter  is  distributed  through  the  house. 

The  National  Board  of  Health  instituted  a  very  elaborate  series 
of  investigations  in  order  to  determine  the  extent  to  which  different 
soils  are  able  to  filter  the  injurious  properties  out  of  the  air  passing 
through  them.  The  most  interesting  report  upon  the  relation  of 
soils  to  health,  by  Profs.  Smyth  and  Pumpelly  can  here  only  be 
referred  to.     Their  conclusions  show  the  utter  worthlessness  of  sand 


16 

as  a  filter  for  germinal  matter.  Our  government  in  no  wiser  way 
could  aid  in  the  general  well  being  of  her  citizens  than  by  the 
continuation  of  such  investigations. 

"  The  facts  here  brought  out  seem  to  us  of  importance  considered 
with  reference  to  the  sources  of  supply  of  our  drinking  waters ;  the 
relative  location  of  wells,  cess-pools,  etc.,  in  our  towns ;  and  also 
w|th  reference  to  the  methods  of  removal  of  excreta,  especially 
during  the  prevalence  of  an  infectious  disease,  the  infectious  mate- 
rials of  which  may  be  communicated  through  water.  A  good  bed 
of  sand  has  commonly  been  regarded  as  one  of  the  most  efficacious 
forms  of  filters,  amply  protecting  our  well  water  against  all  con- 
tamination, even  though  the  wells  be  sunk  at  no  remote  distance 
from  sewers,  cess-pools,  cemeteries,  etc.  But  we  see  that  sand 
utterly  fails  to  remove  germs  of  putrefaction,  such  as  are  normally 
found  in  the  air  and  in  water,  while  its  power  of  absorbing  dis- 
solved matter,  organic  or  inorganic,  must  also  be  seriously 
questioned.1" 

The  subject  of  germ  transmission  through  the  soils  demands  on 
the  part  of  sanitarians  the  most  searching  investigation,  not  only  on 
account  of  the  possibility  of  contamination  of  our  drinking  waters, 
through  infiltration  of  germs,  but  also  because  the  air,  especially  in 
our  dwellings,  may  become  infected  if  the  soils  in  their  natural  con- 
dition possess  no  power  of  retaining  germs  or  their  adult  organisms. 
For  whenever  in  an  infected  soil  the  ground  water  from  any  cause 
rises  to  the  surface,  germs  may  be  carried  with  it,  and  upon  drying 
be  taken  up  by  the  atmosphere. 

The  importance  of  a  supply  of  pure  drinking  water  cannot  be 
over-estimated,  and  its  pollution  is  in  a  very  large  degree  due  to 
germ  contamination.  This  is  no  exception,  even  in  sparsely  settled 
country  districts.  In  New  England,  almost  entirely  exempt  from 
malaria,  the  danger  from  specific  contamination  of  the  drinking 
water  is  shown  in  the  marked  increase  of  typhoid  fever.  In  Massa- 
chusetts alone  there  occurred,  from  1840  to  1880,  390,000  cases  of 
typhoid  fever  and  40,000  deaths. 

In  the  military  service,  during  the  late  bloody  contest  between 
the  States,  zymotic  diseases  caused  a  larger  number  of  deaths  than 
resulted  from  all  the  battles  of  the  entire  war.  We  quote  from  the 
report  of  the  Surgeon  General  :  "  The  entire  number  killed  in 
battle  and  died  as  the  result  of  wounds  was  93,443  ;  died  from  dis- 

1  Supplement  No.  13,  National  Board  of  Health  Bulletin,  p.  18. 


17 

ease,  186,216  ;  died  from  zymotic  diseases  alone,  108,666."  If  to 
these  hecatombs  of  victims  sacrificed  in  the  vigor  of  early  manhood, 
Ave  add  the  suffering  represented  by  over  1,700,000  reported  cases 
of  diarrhoea  and  dysentery,  and  1,100,000  cases  of  malarial  fever, 
every  village  and  hamlet  of  our  broad  domain  still  having  its 
representatives  of  wrecked  humanity  from  these  causes,  we  gain 
some  idea  of  the  dangers  resulting  from  insanitary  conditions, 
although  our  armies  were  in  service  in  a  mild  climate,  and  the  best 
clothed,  fed  and  housed  soldiery  the  world  has  ever  seen. 

The  number  of  deaths  in  the  United  States  during  1880  from 
diphtheria  alone,  was  38,398,  a  proportion  of  51.33  per  1000.  From 
typhoid  fever  there  occurred  22,905  deaths,  a  proportion  of  31.21 
per  1000. 

These  terrible  scourges,  like  consumption,  are  the  messengers  of 
death  which  make  their  daily  visitations,  and  to  which  people  have 
become  so  accustomed  as  to  regard  their  ravages  as  the  inevitable, 
or,  as  the  clergy  have  been  wont  to  express  it,  "the  hand  of  divine 
Providence  laid  heavily  upon  us."  The  medical  profession  talk 
learnedly  of  the  wise  means  adapted  to  the  cure.  Different  schools 
of  pharmacists  have  their  vaunted  remedies ;  but  the  sad,  humiliating 
lesson  of  the  mortality  tables  teaches  that  these  invisible  monsters 
are  stalking  broadcast  over  the  land,  seizing  prince  and  beggar 
alike  in  their  remorseless  grasp. 

Since  the  history  of  man,  the  wise  of  all  generations  have  sought 
for  the  cause  of  disease,  yet  it  would  appear  that  the  key  to  many  of 
these  labyrinthian  mysteries  has  been  reserved  as  one  of  the 
triumphs  of  science  for  the  latter  part  of  the  nineteenth  century.  It 
is  now  generally  conceded  that  the  danger  to  wounds  is  a  particulate 
organic  infection,  which,  like  the  virus  of  inoculation  or  vaccine, 
germinates,  and  induces  systemic  poisoning.  The  whole  subject  of 
modern  wound  treatment  is  based  upon  the  recognition  of  this  ever 
threatening  danger,  and  securing  the  best  means  of  its  avoidance. 
This  recent  recognition  of  the  dangers  from  the  simplest  form  of 
microscopic  vegetable  growth,  has  evoked  the  important  question  of  ' 
the  means  best  adapted  for  their  destruction.  Extremes  of  heat  and 
cold  are  by  far  the  most  universal,  and  are  the  wise  measures  which 
nature  has  adopted  as  limitations  to  their  development.  For  a  long 
time  carbolic  acid  has  been  the  surgeon's  sine  qua  non,  and  the 
agent  most  trusted  for  the  disinfection  of  the  sick-room.  A  long 
series   of  careful   laboratory   investigations   conducted    under  my 


18 

supervision  have  given  results  not  unlike  those  of  Koch  and  Stern- 
berg, and  place  the  bichloride  of  mercury  preeminently  at  the  head 
of  the  list  of  germicides.1  The  solution  of  one  part  to  2000  is  as 
trustworthy  as  the  1  to  20  of  carbolic  acid.  Properly  marked,  to 
guard  against  danger,  such  a  solution  may  be  wisely  brought  into 
requisition  in  every  household.  Under  the  light  of  its  new  values, 
preparations  of  mercury  in  certain  diseases  are  likely  to  be  restored 
to  their  old  time  professional  confidences,  and  teach  that  the  clinical 
deductions  of  the  fathers  were  not  without  foundation  in  fact. 

The  first  of  the  diseases,  and  the  one  the  clear  history  of  which  is 
perhaps  the  best  known,  is  anthrax,  or  malignant  pustule.  Here 
the  role  of  specific  micro-organisms  as  cause  and  effect  has  been 
conceded.  No  more  interesting  subject  could  command  attention 
than  the  analysis  in  detail  of  the  entire  group  of  zymotic  diseases 
In  a  purely  conservative  sense,  it  is  not  too  much  to  claim,  that  it 
may  be  shown  that  each  of  these  affections  has  its  probable  origin 
from,  and  owes  its  dissemination  to,  a  contagium  vivum  of  a  definite, 
particulate  character.  We  do  not,  however,  intend  by  this  to 
convey  the  meaning  that  our  knowledge,  as  yet,  if  ever,  will  enable 
us  to  differentiate  each  individual  factor.  In  the  light  of  recent 
astonishing  discoveries,  no  wise  man  would  prognosticate  a  limit  to 
our  future  knowledge  in  this  direction.  Certainly,  the  greatest 
progress  in  medicine  since  the  days  of  the  fathers  is  this  pertaining 
to  the  causes  of  disease.  It  is  not  too  much  to  predicate  as  possible, 
or  even  probable,  that  the  medical  art,  in  the  near  future,  will  hold 
control  over  the  entire  class  of  zymotic  diseases  as  effectually  as 
vaccine  has  controlled  and  relegated  to  an  almost  hypothetical 
danger  the  terrible  scourge  of  smallpox,  which  ravaged  humanity 
during  the  many  centuries  of  the  historic  past. 

The  laborious  researches  of  our  distinguished  friend,  Dr.  Henry  I. 
Bowditch,  in  establishing  the  relation  of  soil  moisture  to  consump- 
tion, builded  for  himself  a  monument  more  grand  and  enduring 
than  granite  or  bronze.  The  ineffable  something,  the  existence  of 
which  he  was  equally  sure,  remained  for  younger  eyes  to  discover, 
and  the  patient,  pains-taking  labors  of  the  well  trained  German 
student  to  demonstrate  the  specific  bacillus  tuberculosis. 

It  is  very  probable  no  publication  of  modern  time  has  awakened 
so  much  discussion  or  caused  the  undertaking  of  so  great  an  amount 

1  See  American  Medical  Association  Journal,  August,  1883 — "  Germicides 
and  Their  Relative  Values." 


19 

of  study  and  investigation.  Dr.  H.  C.  Ernst,  of  Boston,  read  an 
exhaustive  paper,  upon  this  subject,  in  part  a  contribution  of 
laboratory  work,  before  the  Massachusetts  Medical  Society  in  June 
last.  He  made  a  table  of  references  to  fifty  publications  upon  this 
subject,  and  I  am  quite  sure  I  have  seen  nearly  one-quarter  as 
many  more  articles  published  since  this  date  worthy  of  reference. 
Dr.  Ernst's  conclusions  are  as  follows  : — 

"  I.  A  staff-shaped  micro-organism  exists  in  all  forms  of  the  tuber- 
culous process,  and  its  presence  has  been  demonstrated  in  them. 

"  II.  It  is  more  abundant  in  the  rapid  than  in  the  slow  form  of  the 
process. 

"  III.  Its  specific  nature  as  the  cause  of  tuberculosis  is  claimed  by 
Koch  on  the  ground  of  his  observation. 

"IV.  Its  specific  character  has  not  been  successfully  refuted  by 
trustworthy  observations. 

"  V.  Its  value  as  diagnostic  evidence  of  tuberculosis  is  very  great, 
although  its  absence  cannot  be  considered  as  excluding  that  process." 

The  latest  novelty  in  the  germ  theory  of  disease  is  found  in  the 
ingenious  exposition  of  the  yeast  fungus  as  the  cause  of  diabetes, 
by  Prof.  Ekland,  of  Stockholm.1  It  is  offered  as  theory  rather  than 
demonstration,  and  yet  the  array  of  facts  brought  to  support  this 
explanation,  if  not  conclusive,  throws  at  least  new  light  upon  this 
disease,  which  has  ever  been  considered  a  dark  enigma. 

Dr.  Hassall  communicated  a  paper  upon  the  development  of 
Torulse  in  Urine  to  the  Royal  Medical  and  Chirurgical  Society  of 
London,  in  1853,  in  which  he  arrived  at  the  conclusion  that  there 
is  a  species  of  fungus  which  is  developed  in  urine  containing  even 
minute  traces  of  sugar,  which  may  be  considered  characteristic, 
since  it  occurs  in  no  other  condition  of  the  urine.  Dr.  Beale"'  says  : 
"  This  is  the  sugar  fungus.  But  neither  the  character  nor  the 
occurrence  of  the  fungus  are  sufficiently  constant  to  enable  us  to 
accept  implicitly  Dr.  Hassall's  conclusions  as  to  its  value  as  a  test  for 
the  presence  of  sugar.  The  sugar  fungus  which  grows  in  diabetic 
urine  is  identical  with  the  yeast  plant."  From  the  above  it  would 
appear  that  both  Drs.  Hassall  and  Beale  believed  these  organisms 
developed  only  after  the  exposure  of  the  urine  to  the  atmosphere. 

In  the  archaeological  museum  in  Cambridge  may  be  seen  whole 
series  of  adult  skulls  from  certain  of  the  prehistoric  races  of  South 

1  N.  Y.  Medical  Journal,  July  28,  1882. 

2  "  Kidney  Diseases  and  Urinary  Deposits."     Third  edition,  1870,  p.  393. 


20 

America  with  perfect  teeth.  The  mouths  so  well  furnished  are  alas 
closed  to  our  interrogatories  of  the  why.  The  last  generation  of 
Americans,  living  upon  hot  bread  and  fried  meats,  might  have  been 
described  as  a  teeth-aching  race.  Oar  native  genius,  rising  to  the 
necessity  of  a,  felt  want,  evolved  a  new  profession,  earlier  called  the 
Dentist,  now  the  dental  and  oral  surgeon,  and  the  present  generation 
nmy  be  styled  a  teeth-preserving  and  teeth-manufacturing  people. 
An  army  of  seventeen  thousand  trained  specialists  are  busily  engaged, 
at  an  estimated  annual  cost,  in  the  United  States  alone,  of  from  forty 
to  fifty  millions  of  dollars.  In  the  highest  consideration  this  is 
a  very  imperfect  compensation  for  the  damage  done  these  compara- 
tively  minor  members  of  the  body  by  the  ever-present  micro- 
organisms which  riot  in  this  usually  filthy  cavity.  An  antiseptically 
clean  mouth  and  our  dentists  would  become  rivals  of  the  historic 
Micawber,  and  dyspepsia  be  placed  at  the  bottom  of  the  lists  of 
diseases. 

A  blind  man,  no  matter  how  well  armed  and  how  active,  is  a 
dangerous  ally  ;  his  blows  may  fall  equally  upon  friend  and  foe. 
How  can  one  who  is  blind  as  to  causation  direct  as  to  the  preven- 
tion of  disease  ? 

The  fundamental  basis  of  all  sanitary  law,  and  I  may  also  say  of 
the  treatment  of  disease,  lies  in  the  acquisition  of  such  causative 
knowledge.  The  application  of  sanitary  law  to  city  life  must 
demand  an  atmosphere  reasonably  free  from  the  defilement  of 
organic  waste.  This  necessitates  a  system  of  sewerage  which  shall 
continue  from  the  house  in  a  steady,  unbroken  current  to  its  dis- 
charge at  a  safe  distance  from  habitation.  This  current  should  be 
of  sufficient  rapidity  to  prevent  sedimentation,  and  deliver  the  house 
products  before  time  sufficient  for  putrefaction,  even  in  summer, 
has  elapsed.  This  can  never  happen  in  the  systems  now  in  use  in 
those  cities  situated  upon  the  sea  shore,  since  here  the  sewers  are 
practically  tide-locked  a  large  fraction  of  the  clay,  and  a  cessation  of 
current  with  sewerage  deposit  must  ensue,  while  a  backward  pres- 
sure is  necessarily  produced  upon  the  sewer  air  which,  loaded  with 
organic  products,  must  escape  into  the  house  through  any  one  of  the 
wTater  traps  now  in  use. 

Sewer-gas  poisoning,  which  means  air  changed  not  so  much  in  its 
chemical  constituents  as  defiled  by  organic  impurities,  is  thus  by  no 
means,  in  our  best  constructed  houses,  a  hypothetical  danger,  here 
often  the  greater,  for  the  costly  luxuries  of  water-closets  and  basins 


21 

are  each  a  standing  menace,  and  are  to  be  regarded  with  suspicion. 
Boston,  which  has  and  yet  continues  to  drain  into  its  Back-Bay  and 
harbor  its  sewerage,  by  more  than  fifty  outlets,  is  upon  the  eve  of 
inaugurating  its  new  system  at  an  expanse  of  nearly  $5,000,000,  by 
which  the  sewerage  is  to  be  pumped  into  a  storage  reservoir  situated 
upon  Moon  Island  and  discharged  into  the  out-going  tide,  and  thus 
protect  the  harbor  from  defilement  by  sewer  drainage. 

The  wise  political  economist  and  world-renowned  historian,  Mr. 
George  Bancroft,  in  discussing  the  future  of  civilization,  once  said 
to  me:  "I  look  upon  New  York  city  as  the  future  commercial 
metropolis  of  the  world,  a  great  centre  of  ten  or  fifteen  millions  of 
inhabitants."  This  prophecy  of  years  ago  has  gone  on  toward  a 
steady  fulfillment,  until,  like  London,  she  exacts  tribute  from  the 
entire  world.  Situated  upon  a  narrow  neck  of  land  between  a 
mighty  river  and  a  deep  bay,  it  would  seem  that  good  soil  drainage 
would  be  most  easily  secured  ;  and  yet  her  sanitary  authorities  state 
that  the  imperfect,  incomplete,  and  broken  sewers  have  caused  the 
soil  of  whole  districts  to  become  so  charged  with  sewage  that  the 
saturation  point  is  reached.  Nearly  four  millions  of  people  pour 
their  waste  into  the  river  and  harbor,  as  is  most  convenient,  while 
miles  of  her  shores  are  fringed  with  wooden  wharves  built  upon 
piles,  not  alone  themselves  undergoing  decay,  but  a  fertile  source  of 
detention  of  putrefying  material.  The  New  York  physician  will 
tell  you  that,  no  matter  what  disease  he  has  under  treatment,  the 
added  factor  of  malaria  from  such  defilement  must  be  taken  into 
consideration.  Rich  and  poor  must  alike  suffer  from  such  danger, 
and  if  the  prophecy  of  America's  distinguished  scholar  is  to  be 
fulfilled,  New  York  must  take  her  sewage  out  of  the  harbor,  and 
rival  London  and  Liverpool  with  docks  of  solid  granite  for  the 
merchandise  of  the  globe. 

The  water  supply  must  ever  be  pure  and  ample.  The  extraordi- 
nary expenditure  necessitated  by  most  cities  has  made  water  a 
costly  product.  Rivers  and  lakes  in  sufficient  proximity  for  such 
use  are  liable  to  defilement  from  suburban  towns  and  manufactories, 
and  only  by  the  greatest  vigilance  can  pollution  be  prevented. 
Boston  has  freely  expended  her  millions  upon  a  water  supply  con- 
fessedly inadequate  in  amount,  and  of  a  character  which  is  a  con- 
stantly recurring  source  of  complaint  and  danger.  Much  of  her 
water  supply  is  retained  in  artificial,  shallow  storage  basins,  from 
which  the  surface  soil  was  never  removed,  and  whose  water-shed 


22 

comprises  a  very  considerable  population  ;    and   Natick,  with  its 

8000  inhabitants,  still   drains  its  waste  into  Lake  Cochituate,  the 
original  source  selected  for  the  city  supply. 

The  Board  of  Health  returns  for  Boston,  August,  1883,  out  of  a 
total  of  521,  gives  from  zymotic  diseases  alone  194  deaths,  while 
135  cases  of  typhoid  fever  were  reported. 

For  September,  in  a  total  mortality  of  765,  there  were  253  deaths 
from  zymotic  diseases,  and  215  cases  of  typhoid  fever  were  reported. 

"With  astonished  gaze  the  traveler  views  the  great  arches  span- 
ning and  crossing  the  Campagna,  which  once  bore  to  old  Rome  the 
pure  waters  of  the  distant  Albian  mountains.  The  last  genera- 
tion of  scant  population,  with  singular  energy  and  fore- 
sight, at  the  behest  of  commerce,  wedded  by  a  waterway,  more 
than  three  hundred  miles  in  length,  the  Great  Lakes  with  the  Hud- 
son river.  The  twentieth  century  will  exhibit  yet  greater  marvels 
for  the  securing  of  pure  water.  The  project  is  already  under  dis- 
cussion to  supply  the  great  Metropolis  from  no  nearer  source  than 
Lake  George,  with  the  thought  of  protecting  its  water-shed  fr6m 
further  pollution,  and  carrying  its  pure,  sparkling  water  to  the 
thirsty  city,  at  an  estimated  expense  of  no  less  than  two  hundred 
millions  of  dollars. 

The  danger  from  the  dead  must  not  be  forgotten.  As  we  invite 
our  friends  to  sympathize  in  our  sorrow,  let  it  not  be  to  their  peril. 
Revive,  if  need  be,  the  custom  of  Egyptian  preservation,  or  re- 
inaugurate  the  use  of  the  Roman  funereal  urn,  but  do  not  sow  the 
seeds  of  an  epidemic  of  the  ever  prevalent  contagious  diseases  by  our 
present  display  of  decomposing  remains,  adorned  as  if  for  a  recep- 
tion. Let  the  genius  of  some  sanitarian  devise  a  casket  at  once 
hermetically  sealed,  rather  than  do  violence  to  time  honored  cus- 
tom or  shock  the  deepest  and  most  sacred  feeling  of  broken  hearts 
by  urging  cremation.  The  public  health  act  of  Great  Britain 
makes  the  holding  of  a  "  wake"  over  the  body  of  ©ne  dying  from 
contagious  diseases  subject  to  a  fine  of  five  pounds.  Let  American 
authorities  equally  protect  from  similar  dangers. 

W7e  turn  reluctantly  from  the  consideration  of  questions  having 
so  great  and  vital  an  interest  to  the  medical  profession,  and  of 
primary  importance  to  the  entire  animal  kingdom.  If  Rip  Van 
Winkle  experiences  be  granted  to  us  in  the  twentieth  century,  with 
little  aid  of  the  prophetic  power  we  may  forecast  some  of  the 
advances  then  made  known  to  us  of  our  science.     In  the  li^ht  of 


past  history,  with  its  fashions  and  foibles  of  the  medicamenta,  few 
would  presume  upon  the  mission  of  its  pellets  and  powders. 

Surgery  and  sanitary  scieuce  are,  however,  based  upon  entirely 
different  factors  of  our  knowledge,  and  must  remain  the  great  corner- 
stones of  a  divine  art,  as  wide  reaching  as  humanity.  Upon  these 
shall  be  builded  the  grand  JEsculapian  temple  of  the  future,  where 
will  be  taught  a  science  foreshadowed  in  the  deeds  of  the  great 
Galilean  Master. 

The  citizen  must  not  be  lost  in  the  physician.  A  Republican 
Government  demands  service  of  all.  As  I  turned  from  the  motley 
crowd  in  Castle  Garden  I  shuddered  at  the  thought  that  these  men 
were  so  soon  to  be  my  peers  in  our  government ;  but  the  bright- 
eyed  children,  hiding  in  the  scanty  skirt  of  the  mother,  looked 
hopefully  up,  as  if  to  say,  "  Welcome  us  in  our  escape  from  the 
oppression  and  over-crowding  of  the  centuries."  Then  came  the 
vision  of  our  broad  domain  scattered  all  over  with  school  houses, 
academies  and  colleges.  Rosy-hued  with  health,  in  youthful  vigor, 
our  women  in  tens  of  thousands  have  devoted  their  best  years  to 
the  training  of  the  young.  Four  hundred  American  colleges  and 
universities  with  open  doors  invite  to  a  higher  education.  Universal 
knowledge  is  the  Republic's  only  safety,  and  further  needs  have 
only  to  be  made  known  to  be  liberally  met  by  the  generosity 
of  the  American  people.  The  necessity  for  research  and  pure 
science  are  recognized  as  never  before,  and  may  the  day  soon  come 
when  our  youth  will  no  longer  require,  for  their  best  development 
and  higher  education,  European  training. 

Be  it  our  bounden  duty  as  physicians  to  disseminate  to  the  masses 
proper  instruction  in  the  cardinal  virtues  of  right  living,  and  to 
demand  from  our  government  wise  sanitary  laws,  both  State  and 
National,  in  the  enforcement  of  which  every  house  shall  be  builded 
and  maintained  as  sanitarily  safe  as  architecturally ;  rich  and  poor 
alike  abundantly  supplied  with  pure  air  and  water,  and  have  their 
habitation  upon  an  un contaminated  soil. 


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